EURURO Vol. 72 No. 5

772 860

Platinum Priority – Review – Stone Disease
Editorial by Jacob M. Patterson and William J.G. Finch on pp. 787–788 of this issue
What are the Benefits and Harms of Ureteroscopy Compared with
Shock-wave Lithotripsy in the Treatment of Upper Ureteral
Stones? A Systematic Review
Tamsin Drake Nikolaos Grivas Saeed Dabestani Thomas Knoll Thomas Lam
Steven Maclennan Ales Petrik Andreas Skolarikos Michael Straub Christian Tuerk
Cathy Yuhong Yuan , Kemal Sarica
a Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK; bDepartment of Urology, Hatzikosta General Hospital, Ioannina, Greece;
c Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; dDepartment of Urology, Ska˚ne
University Hospital, Malmo¨, Sweden; e Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tu¨bingen, Sindelfingen, Germany;
f Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland; g Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland; h Department
of Urology, Charles University, First Faculty of Medicine, Prague, Czech Republic; i Department of Urology, Hospital Ceske Budejovice, Czech Republic; j Second
Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece; k Department of Urology, Technical University Munich, Munich,
Germany; l Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; m Division of Gastroenterology & Cochrane UGPD Group, Department of
Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada; n Department of Urology, Dr. Lutfi Kirdar Research and Teaching Hospital,
Istanbul, Turkey
available at
journal homepage:
Article info
Article history:
Accepted April 12, 2017
Associate Editor:
J.-N. Cornu
Keywords:
Shock wave lithotripsy
Ureteroscopy
Ureteral calculi
Urolithiasis
Abstract
Context: Extracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS), with or
without intracorporeal lithotripsy, are the most common treatments for upper ureteric
stones. With advances in technology, it is unclear which treatment is most effective and/
or safest.
Objective: To systematically review literature reporting benefits and harms of SWL and
URS in the management of upper ureteric stones.
Evidence acquisition: Databases including Medline, Embase, and the Cochrane library
were searched from January 2000 to November 2014. All randomised controlled trials
(RCTs), quasi-randomised controlled trials, and nonrandomised studies comparing any
subtype or variation of URS and SWL were included. The primary benefit outcome was
stone-free rate (SFR). The primary harm outcome was complications. Secondary out-
comes included retreatment rate, need for secondary, and/or adjunctive procedures. The
Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to
assess nonrandomised studies. Grading of Recommendations Assessment, Develop-
ment, and Evaluation was used to assess the quality of evidence.
Evidence synthesis: Five thousand-three hundred and eighty abstracts and 387 full-text
articles were screened. Forty-seven studies met inclusion criteria; 19 (39.6%) were RCTs.
No studies on children met inclusion criteria. URS and SWL were compared in 22 studies
(4 RCTs, 1 quasi-randomised controlled trial, and 17 nonrandomised studies). Meta-
analyses were inappropriate due to data heterogeneity. SFR favoured URS in 9/22
studies. Retreatment rates were higher for SWL compared with URS in all studies
but one. Longer hospital stay and adjunctive procedures (most commonly the insertion
of a JJ stent) were more common when primary treatment was URS. Complications were
* Corresponding author. Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training
Hospital, Istanbul, Turkey. Tel. +90 216 441 39 00; Fax: +90 216 305 5110.
E-mail addresses: , (K. Sarica).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.